Healthcare Provider Details

I. General information

NPI: 1982936852
Provider Name (Legal Business Name): BRIDGEWAY BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 W WENDOVER AVE
HIGH POINT NC
27265-9177
US

IV. Provider business mailing address

1570 S MAIN ST
SAINT CHARLES MO
63303-4149
US

V. Phone/Fax

Practice location:
  • Phone: 336-845-3988
  • Fax:
Mailing address:
  • Phone: 636-757-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MIKE MORRISON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 636-757-2200